Insulin Detemir

Indications

Insulin Detemir is used for: Diabetes mellitus

Adult Dose

Subcutaneous Type I or II Diabetes Mellitus Once daily dosage: Administer SC with evening meal or at bedtime Twice daily dosage: Administer SC with morning meal and either with evening meal, at bedtime, or 12 hr after the morning dose Initial dose Type 1 diabetes: Approximately one third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements; usual daily maintenance range is 0.5-1 unit/kg/day in divided doses; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.6-1.2 units/kg/day Type 2 diabetes inadequately controlled on oral medication: 10 units/day SC (or 0.1-0.2 unit/kg/day) in evening or divided q12hr Type 2 diabetes inadequately controlled on GLP-1 receptor agonist: 10 units/day SC given once daily in evening Subsequently adjust dose based on blood glucose measurements Conversion from other insulins If converting from insulin glargine: Change can be accomplished on a unit-to-unit basis If converting from NPH insulin: Change can be accomplished on a unit-to-unit basis; however, some patients with type 2 diabetes may require more insulin detemir than NPH insulin Closely monitor blood glucose during transition and in the initial weeks thereafter; concurrent rapid-acting or short-acting insulins or other concomitant antidiabetic treatment may require dose adjustment Dosing Considerations Dosage of human insulin, , must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect Dose adjustments should be based on regular blood glucose testing Adjust to achieve appropriate glucose control Dose adjustments Look for consistent pattern in blood sugars for >3 days

Child Dose

Subcutaneous Type 1 Diabetes Mellitus <2 years: Safety and efficacy not established >2 years: Approximately one-third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements; usual daily maintenance range in adolescents is <1.2 units/kg/day during growth spurts

Renal Dose

Renal impairment: Dose adjustments may be needed.

Administration

Administer subcutaneously in the upper arm, thigh or abdominal wall. A subcutaneous injection into the abdominal wall results in a faster absorption than from other injection sites. May be taken with or without food. For patients treated w/ once daily regimen, administer w/ evening meal or at bedtime. For patients who need twice daily dosing, the evening dose can be administered either w/ the evening meal or at bedtime or 12 hr after the morning dose.

Contra Indications

Do not admin by IV, IM or via insulin infusion pump.

Precautions

Renal or hepatic impairment. Regular monitoring of blood glucose and HbA1c. Continuous rotation of the inj site within a given area to reduce inj site reactions. Pregnancy, lactation Lactation: Safe

Pregnancy-Lactation

Pregnancy category: B; randomized, controlled trial (n=310) observed insulin detemir reduced Hgb A1C similarly to insulin NPH in pregnant women; no differences observed in fetuses and newborns Lactation: Safe

Interactions

Possible absence of hypoglycaemic warning symptoms with beta-blockers. Increased blood sugar with thiazide diuretics, corticosteriods, chlorpromazine, tibolone, isoniazid, niacin, some calcium-channel blockers such as diltiazem or nifedipine, diazoxide, lithium and thyroid hormones. Increased risk of hypoglycemia with disopyramide, larges doses of aspirin, gatifloxacin, MAOIs, mebanazine, nandrolone, pegvisomant, testosterone. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.

Adverse Effects

Side effects of Insulin Detemir : Hypoglycaemia, lipodystrophy, pruritus, rash, wt gain, sodium retention and oedema. Inj site reactions e.g. pain, itching, hives, swelling and inflammation. Influenza-like symptoms, Pallor, Palpitation, Tachycardia, Mental confusion, Weakness, Blurred vision, Itching, Hunger, Nausea.

Mechanism of Action

Insulin detemir is a recombinant human insulin analogue which is long-acting. It is prepared using recombinant DNA technology and genetically modified cultures of Saccharomyces cerevisiae. Slow systemic absorption and reversible binding to albumin may account for the prolonged duration of action of insulin detemir.